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COVID-19 doesn’t care how old you are, your position in life or how healthy you seem to be. It doesn’t care about how other diseases work, even when it looks closely related to them.
This terrible new enemy wreaks havoc on its victims, unchecked and unphased by any and all therapies we throw at it. Only recently have we identified a well-known, simplistic but effective intervention – proning (putting patients on their stomach) – as being efficacious. But it’s not a cure, simply a way to buy time for patients to hopefully heal on their own.
COVID-19 leaves physicians feeling inept and weaponless in this battle. We push experimental therapies, adapt interventions meant for other diseases with limited success and chase laboratory values that would otherwise spell impending disaster yet rapidly correct days later without intervention.
It feels as if we are shooting arrows against a brick wall in a feeble attempt to breach it; any crack in the mortar is a hope that is dashed away by the fact the wall still stands. Yet, we all carry on.
On the orders of physicians, our teammates in nursing, physical therapy and respiratory therapy are donning re-used and decontaminated protective gear (meant to be worn once) to enter the rooms of infected patients innumerable times per shift to draw labs, adjust infusion doses and help to prone them. This exposes them to the virus time and time again. Each decision we make as physicians to obtain an additional lab or add a new medication weighs on us that much more.
This all takes a significant toll on the mental health of our health care providers. While we are used to dealing with difficult situations and death, this is a whole new beast. This unseen enemy threatens us directly and constantly. Did I touch my mask before washing my hands? What about when I adjusted my glasses? Did I just infect myself? These thoughts cross our minds hundreds of times throughout the day.
COVID-19 lives in our workplaces, in our neighborhoods and in our own homes. Arriving home each day, even though I leave my hospital scrubs and shoes at work, I still take my shoes off outside my door and disrobe completely after entering my house. I immediately throw my street clothes in the wash and jump in the shower to get clean – scrubbing under every fingernail and inch of my body. I wipe down my phone, keys, wallet and backpack with disinfecting wipes and then wash my hands again.
As hard as this is for the patients and health care providers, it is worse for families. They are unable to see just how sick and close to death their loved ones are. It’s almost impossible to comprehend that their loved one could get this sick, this quickly, when days earlier they were walking around in the park together.
It’s hard to explain but what often happens is these patients were maintaining some baseline level of function but underneath, they were likely sitting on the edge of a cliff that was only revealed once they were infected with COVID-19. Then the curtain was pulled back and we could see how unhealthy they really were. We see this in “otherwise healthy” younger patients who have undiagnosed high blood pressure, high cholesterol and obesity. And, of course, older patients who before the virus could “manage just fine,” but needed assistance with daily activities or couldn’t really walk more than a few feet without stopping.
We break down. We cry. We feel our breath get short and chest get tight. “Is this COVID or just anxiety?” we wonder.
The families plead with us on Zoom calls, asking for experimental therapies they saw on TV or in an Internet search. How do you explain that these are just experimental, not always available and, in the age of evidence-based medicine, will not likely be administered without a clinical trial to evaluate effectiveness? While always grateful for our efforts, they continue to push and push, offering to send us articles and news stories, and who can blame them? I would want everything to be tried for my family member as well – even if there is no evidence for it. But that’s not how medicine works.
While connecting with patients and families has always been a significant part of the job for ICU doctors, it has become almost a full-time endeavor – explaining behind a mask and over video conference with our palliative care colleagues, why we can’t “just inject donor plasma” into their loved one. The emotional burden weighs heavy as well, from family members who feel guilty for infecting their loved one, to those whose family member we suggest is made “do not resuscitate” because they likely wouldn’t benefit from chest compressions if their heart stopped.
They inevitably break down crying, inconsolable. And it is made all the worse because we cannot reach out to hold their hand from behind a screen.
We break down too, inside. We look at each other after these calls – “That was terrible. This is terrible. What else can we do?” Nothing. And so, we get on, calling the next family. Because that’s all we can do. It is overwhelming, yet we hold it together for the families and each other.
The virus is constantly on our minds and feels impossible to escape. Even when we’re off duty it sits there. In the conversations with families that we replay in our minds. In the burden of knowing we asked the seasoned nurse, a member of the higher risk age groups, to enter the room and expose herself to the virus again. In the questions and concerns from our own families. And constantly, unwaveringly, on TV.
We break down. We cry. We feel our breath get short and chest get tight. “Is this COVID or just anxiety?” we wonder. Some reach out to professionals or colleagues to talk, others meditate or run. Some self-medicate with alcohol while others just bundle it all back inside.
The day ends, the dreams begin and then we wake up to do it all over again.